Saturday, July 4, 2015

In the 71 days since she first saw her doctor about a suspicious lump in her right breast, Ricki Harvey has had 40 appointments about her medical care. First came the mammogram, the ultrasound and the biopsy. Then meetings with the surgical oncologist, the radiation oncologist, the general oncologist, the social worker, the geneticist and the physical therapist. Then her twice-weekly chemotherapy infusions.

At Harvey's side every step of the way were "patient navigators" — in her case, nurses — whose job is to help guide cancer patients through a system that has become so complex and fragmented that it is beyond the ken of many people, especially at such a vulnerable time.

Many patients rave about them, calling them a godsend. "Some people have to do this all on their own," said Harvey, 65, a retired elementary school principal from McLean, Va. "I can't even imagine."

Yet so far, research shows that, with the possible exception of poor people who typically don't receive sufficient medical care, navigators have only a modest effect on how well patients do. There is little evidence that they save money. And research on patient satisfaction is mixed.

Those findings have relevance as the health-care system moves from a fee-for-service model to one that rewards high-quality care. Doctors and hospitals are under growing pressure to rein in costs and show that every new initiative has value. But value can be subjective and difficult to measure. Are navigators, for example, a nice add-on service that merely reassures patients, or do they contribute much more?

"I think for a lot of patients, maybe even the majority of patients with cancer, navigation may not have that big an impact on the kind of care they get," said Scott Ramsey, a professor of public health sciences at the Fred Hutchinson Cancer Research Center in Seattle, who studied the ­cost-effectiveness of navigators in a large National Cancer Institute project.